Experience the Eide Bailly DifferenceA Method to the MadnessPricing Physician Services
www.eidebailly.comPricing Physician Services• David Manning, CPA,CMPE• Manager in Health CareConsulting, Eide Bailly LLP• ...
www.eidebailly.comPricing Physician ServicesMadness?Method?What is it about pricingphysician services that isso frustrating?
www.eidebailly.comPricing Physician ServicesGross Charge
www.eidebailly.comPricing Physician ServicesOnly 15,471 Rows!Medicare Physician Fee Schedule
www.eidebailly.comPricing Physician ServicesMadness?We get caught up in the complexities ofproviding services:• Eligibilit...
www.eidebailly.comPricing Physician ServicesMake money the oldfashioned way –We smile and lookcute until someonehas pity o...
www.eidebailly.comPricing Physician ServicesPrice? – What the market will bear!But what if the girlsdown the street setupa...
www.eidebailly.comPricing Physician ServicesAnd what if they’re really cute?Lemonade Stand
www.eidebailly.comPricing Physician ServicesPrice?– Time to slash prices!But how low can you go?Lemonade StandX 15¢
www.eidebailly.comPricing Physician ServicesWhat about your costs?Costs? I thought Mom bought thelemonade?OK: Lemonade Mix...
www.eidebailly.comPricing Physician ServicesLet’s see…If we sell for 15¢…And our costs are 15¢We going toneed aBigger Truc...
www.eidebailly.comPricing Physician Services“All I Really Needed to Know I Learned InKindergarten”- Robert FulghumReally? ...
www.eidebailly.comPricing Physician ServicesThe FourFundamentals1. Cover Your Costs2. Leave Nothing Behind3. Know Your Mar...
www.eidebailly.comPricing Physician Services1. Cover Your Costs• Provider labor• Clinical staff• Front office, business of...
www.eidebailly.comPricing Physician Services1. Cover Your Costs• Detailed cost reporting system?• Can your practice track ...
www.eidebailly.comPricing Physician ServicesThe Resource-Based Relative Value Scale(RBRVS) was researched at HarvardUniver...
www.eidebailly.comPricing Physician Services1. Cover Your CostsMedicare Relative Value System (RVUs)(3 Components)o Work R...
www.eidebailly.comPricing Physician Services1. Cover Your CostsMedicare Relative Value System (RVUs)ProviderWorkRVUsPracti...
www.eidebailly.comPricing Physician Services1. Cover Your CostsTotal RVU’s are then multiplied by adollar value conversion...
www.eidebailly.comPricing Physician Services1. Cover Your CostsBut, the costs of delivering medicalcare vary across the co...
www.eidebailly.comPricing Physician ServicesMedicare Physician Fee Schedulepayments are calculated:RVU – Relative Value Un...
www.eidebailly.comPricing Physician ServicesMedicare Physician Fee Schedulepayments for each CPT code:WorkRVUXWorkGPCIPrac...
www.eidebailly.comPricing Physician ServicesLocalityAdjusted TotalRVUs$ ConversionFactorRVU BasedPaymentx =Medicare Physic...
www.eidebailly.comPricing Physician ServicesTotal LocalityAdjustedRVUsCost AllocationFactorTotal OperatingCosts =÷1. Cover...
www.eidebailly.comPricing Physician Services1. Cover Your Costs• The Cost Allocation Factor usedin conjunction with Locali...
www.eidebailly.comPricing Physician Services1. Cover Your Costs• $38.24 (Cost Allocation Factor)Medicare currently pays $3...
www.eidebailly.comPricing Physician Services1. Cover Your Costs• On average, you’ll need to bepaid more than $38.24 per RV...
www.eidebailly.comPricing Physician Services1. Cover Your Costs• You’ll need to average $54.54- just to break evenCover Yo...
www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• We’re not talking about“Leave no man behind”
www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• We’re talking about“Leave no money behind!”
www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• Medicare PFS, Lab, Drugs, DME• Medicaid, Lab, DME• Co...
www.eidebailly.comPricing Physician Services2. Leave Nothing BehindAll Pay on a contracted Fee ScheduleBut, they will pay:...
www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• Commercial % of Charge• Self Pay PatientsGranted, the...
www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• Inventive: Set charge at leastabove the highest maxim...
www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• Line up fee schedule maximumallowable amounts and com...
www.eidebailly.comPricing Physician Services2. Leave Nothing BehindLocality Adj Facility ConversionCPT Code Total RVUs Pay...
www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• We’ve identified the maximum ofthe Maximum Allowable ...
www.eidebailly.comPricing Physician Services3. Know Your Market
www.eidebailly.comPricing Physician Services3. Know Your Market• How far does your marketstretch?• What other providers ar...
www.eidebailly.comPricing Physician Services3. Know Your MarketHow far does your market stretch?• Unless you’re a regional...
www.eidebailly.comPricing Physician Services3. Know Your MarketWhat other providers are in yourmarket?• How far will your ...
www.eidebailly.comPricing Physician Services3. Know Your Market
www.eidebailly.comPricing Physician Services3. Know Your Market• Everybody guesses 1st• Top group compete for 2nd(top grou...
www.eidebailly.comPricing Physician Services3. Know Your MarketA Gallon of Milk PriceSupermarket ?Big Box Market ?Gas Stat...
www.eidebailly.comPricing Physician Services3. Know Your MarketWhere are you in the health caremarketplace?• Price leader ...
www.eidebailly.comPricing Physician Services3. Know Your MarketSources of Market Knowledge• Patients (employees)• Mystery ...
www.eidebailly.comPricing Physician Services3. Know Your MarketSources of Market KnowledgeIngenix Custom Fee Analyzer Samp...
www.eidebailly.comPricing Physician Services3. Know Your MarketSources of Market KnowledgeOur Cost Allocation Factor for 9...
www.eidebailly.comLocality Maximum Max Allow Ingenix IngenixAdjusted Allowable Conversion Area ConversionCPT Total RVUs Fe...
www.eidebailly.comLocality Current Proposed Proposed ProposedAdjusted Clinic RVU BASED Increase PercentageCPT Total RVUs F...
www.eidebailly.comPricing Physician Services4. Play Fair
www.eidebailly.comLocality Current Proposed Proposed ProposedAdjusted Clinic RVU BASED Increase PercentageCPT Total RVUs F...
www.eidebailly.comPricing Physician Services4. Play FairCalculating RVU Based ReimbursementIs a fee of more than 11 times ...
www.eidebailly.comPricing Physician Services4. Play FairManagement must apply local marketinformation and business judgmen...
www.eidebailly.comPricing Physician Services4. Play FairThe majority of providers generate 80 to90 percent of their revenu...
www.eidebailly.comPricing Physician Services4. Play FairMany existing fees are significantlydifferent from RVU based fees....
www.eidebailly.comPricing Physician Services4. Play FairThe clinic may establish a ceiling amountabove which they will not...
www.eidebailly.comPricing Physician Services4. Play FairA phased approach to arriving at RVUbased fees can mitigate the im...
www.eidebailly.comPricing Physician ServicesHow to handle new fees• Do we have RVUs?• Do we have payer fee schedules?• Do ...
www.eidebailly.comPricing Physician ServicesHow do we handle laboratory,drugs, vaccines, DME andother items without RVUs?•...
www.eidebailly.comPricing Physician ServicesProvider-based billing?• Provider-based billing splits professionaland technic...
www.eidebailly.comPricing Physician ServicesProvider-based billing?• Technical fee is balance of global fee• Because techn...
www.eidebailly.comPricing Physician ServicesThe FourFundamentals1. Cover Your Costs2. Leave Nothing Behind3. Know Your Mar...
www.eidebailly.comCompelling Clinic MetricsDavid Manning, CPA, CMPEManager in Health Care Consulting,Eide Bailly, LLPT. 70...
www.eidebailly.comCompelling Clinic MetricsWho Has the FirstQuestion?
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Pricing Physician Services

A systematic approach to pricing physician services that provides a method to the madness of healthcare pricing. The presentation presents several steps to creating a strategy for pricing services that recognizes both covering one's costs as well as responding to market forces and sensativity. The goal is to help physicians prepare a rationale for pricing their services in the healthcare marketplace.
Published on: Mar 4, 2016
Published in: Health & Medicine      Business      
Source: www.slideshare.net


Transcripts - Pricing Physician Services

  • 1. Experience the Eide Bailly DifferenceA Method to the MadnessPricing Physician Services
  • 2. www.eidebailly.comPricing Physician Services• David Manning, CPA,CMPE• Manager in Health CareConsulting, Eide Bailly LLP• 20+ years in health care• Former manager of severalclinics, both hospital ownedand private practice• T. 701-476-8334• dmanning@eidebailly.com
  • 3. www.eidebailly.comPricing Physician ServicesMadness?Method?What is it about pricingphysician services that isso frustrating?
  • 4. www.eidebailly.comPricing Physician ServicesGross Charge
  • 5. www.eidebailly.comPricing Physician ServicesOnly 15,471 Rows!Medicare Physician Fee Schedule
  • 6. www.eidebailly.comPricing Physician ServicesMadness?We get caught up in the complexities ofproviding services:• Eligibility and prior authorizations• Copayment collection• Appeals and denials• Bonus payments and penalties• Reimbursement calculationsAt the end of the day, it can be exhausting!
  • 7. www.eidebailly.comPricing Physician ServicesMake money the oldfashioned way –We smile and lookcute until someonehas pity on us!Lemonade Stand
  • 8. www.eidebailly.comPricing Physician ServicesPrice? – What the market will bear!But what if the girlsdown the street setupa competing stand?Lemonade Stand
  • 9. www.eidebailly.comPricing Physician ServicesAnd what if they’re really cute?Lemonade Stand
  • 10. www.eidebailly.comPricing Physician ServicesPrice?– Time to slash prices!But how low can you go?Lemonade StandX 15¢
  • 11. www.eidebailly.comPricing Physician ServicesWhat about your costs?Costs? I thought Mom bought thelemonade?OK: Lemonade Mix 8¢ /glassLemon slice 7¢ /glassLabor…..(Dad, I’m 12!) 0¢ /glassTotal operating costs 15¢ /glassLemonade Stand
  • 12. www.eidebailly.comPricing Physician ServicesLet’s see…If we sell for 15¢…And our costs are 15¢We going toneed aBigger Truck!Lemonade Stand
  • 13. www.eidebailly.comPricing Physician Services“All I Really Needed to Know I Learned InKindergarten”- Robert FulghumReally? Sometimes I wonder.
  • 14. www.eidebailly.comPricing Physician ServicesThe FourFundamentals1. Cover Your Costs2. Leave Nothing Behind3. Know Your Market4. Play FairMethod:
  • 15. www.eidebailly.comPricing Physician Services1. Cover Your Costs• Provider labor• Clinical staff• Front office, business office &administration• Supplies• Equipment• Facilities & overhead
  • 16. www.eidebailly.comPricing Physician Services1. Cover Your Costs• Detailed cost reporting system?• Can your practice track coststo the procedure level?• Overhead to a daily total?
  • 17. www.eidebailly.comPricing Physician ServicesThe Resource-Based Relative Value Scale(RBRVS) was researched at HarvardUniversity in the 1980’s. RVU’s have beenin use by CMS since 1992.RVS Update Committee (RUC)
  • 18. www.eidebailly.comPricing Physician Services1. Cover Your CostsMedicare Relative Value System (RVUs)(3 Components)o Work RVUs (WRVUs)o Practice Expense RVUs (PE RVUs)- Non-Facility PE RVUs- Facility PE RVUso Malpractice RVUs (MP RVUs)Professional Liability Insurance (PLI)
  • 19. www.eidebailly.comPricing Physician Services1. Cover Your CostsMedicare Relative Value System (RVUs)ProviderWorkRVUsPracticeExpenseRVUsMalpracticeExpenseRVUsTotalRVUs+ + =
  • 20. www.eidebailly.comPricing Physician Services1. Cover Your CostsTotal RVU’s are then multiplied by adollar value conversion factor to arriveat a payment for the procedure.TotalRVUs$ ConversionFactorMedicarePaymentx =
  • 21. www.eidebailly.comPricing Physician Services1. Cover Your CostsBut, the costs of delivering medicalcare vary across the country.To adjust for cost differences fromregion to region, CMS calculates andapplies Geographic Practice CostIndices (GPCIs):• Work GPCI• Practice Expense GPCI• Malpractice GPCI
  • 22. www.eidebailly.comPricing Physician ServicesMedicare Physician Fee Schedulepayments are calculated:RVU – Relative Value UnitGPCI – Geographic Practice Cost IndexMedicarePayment=WorkRVUXWorkGPCIPracticeExpenseRVUXPracticeExpenseGPCIMalpracticeExpense RVU XMalpracticeExpenseGPCI++ XPaymentConversionFactor ($)
  • 23. www.eidebailly.comPricing Physician ServicesMedicare Physician Fee Schedulepayments for each CPT code:WorkRVUXWorkGPCIPracticeExpenseRVUXPracticeExpenseGPCIMalpracticeExpense RVU XMalpracticeExpenseGPCI++ =Locality AdjustedTotal RVUs
  • 24. www.eidebailly.comPricing Physician ServicesLocalityAdjusted TotalRVUs$ ConversionFactorRVU BasedPaymentx =Medicare Physician Fee Schedulepayments are calculated:
  • 25. www.eidebailly.comPricing Physician ServicesTotal LocalityAdjustedRVUsCost AllocationFactorTotal OperatingCosts =÷1. Cover Your Costs• But what about costs?• Let’s rework the formula:Units ofProduction Cost per UnitOperatingCosts=÷
  • 26. www.eidebailly.comPricing Physician Services1. Cover Your Costs• The Cost Allocation Factor usedin conjunction with LocalityAdjusted RVU’s for each CPTcode can be used as a proxycost accounting system.• Allows for cost allocation at theCPT code level
  • 27. www.eidebailly.comPricing Physician Services1. Cover Your Costs• $38.24 (Cost Allocation Factor)Medicare currently pays $34.04per RVUTotal Operating Costs 342,592$Total RVUs (Annual) 8,958Total Op Cost per RVU 38.24$
  • 28. www.eidebailly.comPricing Physician Services1. Cover Your Costs• On average, you’ll need to bepaid more than $38.24 per RVUin order to stay solvent• Can this knowledge inform yourpricing and contractnegotiations?
  • 29. www.eidebailly.comPricing Physician Services1. Cover Your Costs• You’ll need to average $54.54- just to break evenCover Your Costs!FacilityCPT Code WRVUs PE RVUs MP RVUs Total RVUs99213 0.97 0.42 0.07 1.4600GPCI Factors 1.000 1.000 0.517Locality AdjTotal RVUs 0.97 0.42 0.03619 1.4262Cost Allocation Factor 38.24$Break Even Point for 99213 54.54$
  • 30. www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• We’re not talking about“Leave no man behind”
  • 31. www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• We’re talking about“Leave no money behind!”
  • 32. www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• Medicare PFS, Lab, Drugs, DME• Medicaid, Lab, DME• Commercial Fee SchedulesAll Pay on a contracted Fee Schedule
  • 33. www.eidebailly.comPricing Physician Services2. Leave Nothing BehindAll Pay on a contracted Fee ScheduleBut, they will pay:“The lesser of billed charges or thenegotiated fee schedule amount”Your Charge Allowable
  • 34. www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• Commercial % of Charge• Self Pay PatientsGranted, these payers/patients paybased on whatever is charged.
  • 35. www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• Inventive: Set charge at leastabove the highest maximumallowable amount• Or receive lesser amount whenadditional reimbursement couldhave been received
  • 36. www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• Line up fee schedule maximumallowable amounts and compareto identify the largest allowableamount• This is the threshold below whichyou have left dollars on the table
  • 37. www.eidebailly.comPricing Physician Services2. Leave Nothing BehindLocality Adj Facility ConversionCPT Code Total RVUs Payment Factor99213 1.426246.78$ 32.80$42.81$ 30.02$71.00$ 49.78$71.41$ 50.07$MedicareMedicaidBig CommercialSmaller Commercial
  • 38. www.eidebailly.comPricing Physician Services2. Leave Nothing Behind• We’ve identified the maximum ofthe Maximum Allowable Amounts• This is a virtual floor below whichyou likely will not go
  • 39. www.eidebailly.comPricing Physician Services3. Know Your Market
  • 40. www.eidebailly.comPricing Physician Services3. Know Your Market• How far does your marketstretch?• What other providers are in yourmarket?• What are you core services?• Where are you in the health caremarketplace?• Market knowledge?
  • 41. www.eidebailly.comPricing Physician Services3. Know Your MarketHow far does your market stretch?• Unless you’re a regional tertiaryprovider, your market likely matcheslocal or regional retail markets• Amazon.com, Walmart?• Abuse your local marketplace andmake big profits, and you’ll invite in bigbox competition
  • 42. www.eidebailly.comPricing Physician Services3. Know Your MarketWhat other providers are in yourmarket?• How far will your patients travel forservices with competitors?• Retail travel patterns• Compete or collaborate?(But do not conspire)
  • 43. www.eidebailly.comPricing Physician Services3. Know Your Market
  • 44. www.eidebailly.comPricing Physician Services3. Know Your Market• Everybody guesses 1st• Top group compete for 2nd(top group could be within 25c or top10)• Top two compete for 3rd price• Farmer’s Cost is tie-breaker• Prize is Cookies & Milk
  • 45. www.eidebailly.comPricing Physician Services3. Know Your MarketA Gallon of Milk PriceSupermarket ?Big Box Market ?Gas Station ?Tie BreakerFarmer’s Costs $3.15
  • 46. www.eidebailly.comPricing Physician Services3. Know Your MarketWhere are you in the health caremarketplace?• Price leader / volume dependent• Convenience store• Boutique
  • 47. www.eidebailly.comPricing Physician Services3. Know Your MarketSources of Market Knowledge• Patients (employees)• Mystery shopper• Associations & publications• Government reports• Commercial databases (e.g. IngenixCustom Fee Analyzer)
  • 48. www.eidebailly.comPricing Physician Services3. Know Your MarketSources of Market KnowledgeIngenix Custom Fee Analyzer Sample:For a provider specific GeoZIP areaArea Area Area Area Area Area AreaCPT 50th 60th 75th 80th 85th 90th 95th99211 59 61 66 66 68 72 8199212 83 85 92 94 96 101 11499213 106 109 117 119 123 129 14699214 152 156 169 172 177 186 21099215 242 249 270 273 282 296 335DescriptionOffice/outpatientvisitestL1Office/outpatientvisitestL2Office/outpatientvisitestL3Office/outpatientvisitestL4Office/outpatientvisitestL5
  • 49. www.eidebailly.comPricing Physician Services3. Know Your MarketSources of Market KnowledgeOur Cost Allocation Factor for 99213 is $54.54• Remember there is cost shifting going onLocality Adj Area ConversionCPT Total RVUs 75th Factor99211 0.2652 66.00$ 248.90$99212 0.7207 92.00$ 127.66$99213 1.4262 117.00$ 82.04$99214 2.1917 169.00$ 77.11$99215 3.0824 270.00$ 87.59$
  • 50. www.eidebailly.comLocality Maximum Max Allow Ingenix IngenixAdjusted Allowable Conversion Area ConversionCPT Total RVUs Fee Schedule Factor 75th Factor99211 0.2652 17.93$ 70.17$ 66.00$ 248.90$99212 0.7207 36.25$ 52.28$ 92.00$ 127.66$99213 1.4262 71.41$ 51.95$ 117.00$ 82.04$99214 2.1917 109.83$ 51.97$ 169.00$ 77.11$99215 3.0824 154.03$ 51.82$ 270.00$ 87.59$Average 55.64$ 124.66$Pricing Physician Services3. Know Your MarketCalculating RVU Based Reimbursement
  • 51. www.eidebailly.comLocality Current Proposed Proposed ProposedAdjusted Clinic RVU BASED Increase PercentageCPT Total RVUs Fee Schedule Fee (Decrease) ChangeE&MConversion Factor 98.00$99211 0.2652 103.00$ 26.00$ (77.00)$ -75%99212 0.7207 113.00$ 70.60$ (42.40)$ -38%99213 1.4262 139.00$ 139.80$ 0.80$ 1%99214 2.1917 205.00$ 214.80$ 9.80$ 5%99215 3.0824 275.00$ 302.10$ 27.10$ 10%Pricing Physician Services3. Know Your MarketCalculating RVU Based Reimbursement
  • 52. www.eidebailly.comPricing Physician Services4. Play Fair
  • 53. www.eidebailly.comLocality Current Proposed Proposed ProposedAdjusted Clinic RVU BASED Increase PercentageCPT Total RVUs Fee Schedule Fee (Decrease) ChangeE&MConversion Factor 98.00$99211 0.2652 103.00$ 26.00$ (77.00)$ -75%99212 0.7207 113.00$ 70.60$ (42.40)$ -38%99213 1.4262 139.00$ 139.80$ 0.80$ 1%99214 2.1917 205.00$ 214.80$ 9.80$ 5%99215 3.0824 275.00$ 302.10$ 27.10$ 10%Pricing Physician Services4. Play FairCalculating RVU Based ReimbursementIs a 75% decrease or 10% increase OK?
  • 54. www.eidebailly.comPricing Physician Services4. Play FairCalculating RVU Based ReimbursementIs a fee of more than 11 times the marketfee appropriate? Fair?Locality Maximum Ingenix ProposedAdjusted Allowable Area RVU BASEDCPT Total RVUs Fee Schedule 75th Fee65205 1.1636 120.56$ 18.00$ 203.63$
  • 55. www.eidebailly.comPricing Physician Services4. Play FairManagement must apply local marketinformation and business judgment to theprocess of setting and evaluating fees.Being 11 times higher than market mayhave a reasonable explanation.
  • 56. www.eidebailly.comPricing Physician Services4. Play FairThe majority of providers generate 80 to90 percent of their revenue on 25 or fewerprocedure codes.A significant impactcan be made byfocusing on thesetop codes.
  • 57. www.eidebailly.comPricing Physician Services4. Play FairMany existing fees are significantlydifferent from RVU based fees.The clinic may justify a minimum chargeamount regardless of RVU value. Forinstance a minimum $50 charge for aprovider visit regardless of the RVU valuetop cover the basic costs of being seen.
  • 58. www.eidebailly.comPricing Physician Services4. Play FairThe clinic may establish a ceiling amountabove which they will not charge, even ifthe market is above this level (e.g. 7 timesMedicare, etc.).
  • 59. www.eidebailly.comPricing Physician Services4. Play FairA phased approach to arriving at RVUbased fees can mitigate the impact oflarge price variances.
  • 60. www.eidebailly.comPricing Physician ServicesHow to handle new fees• Do we have RVUs?• Do we have payer fee schedules?• Do we know the costs?• Is there a substantially similarprocedure that we have data for?
  • 61. www.eidebailly.comPricing Physician ServicesHow do we handle laboratory,drugs, vaccines, DME andother items without RVUs?• Not paid on RVUs• Reimbursement basedon retail or other benchmarks• Use times government ratio to setrational fees or other reference (such ascost)
  • 62. www.eidebailly.comPricing Physician ServicesProvider-based billing?• Provider-based billing splits professionaland technical components• We recommend first establishing a globalfee for all non-governmental payers• Then, set 80% of the global as theprofessional fee.• Evaluate professional fee to leave nothingbehind
  • 63. www.eidebailly.comPricing Physician ServicesProvider-based billing?• Technical fee is balance of global fee• Because technical fee is paid onretrospective settlement of costs, price isrelevant only for copayment amount.• Patients pay copayment amount on bothprofessional and technical components
  • 64. www.eidebailly.comPricing Physician ServicesThe FourFundamentals1. Cover Your Costs2. Leave Nothing Behind3. Know Your Market4. Play FairReview:
  • 65. www.eidebailly.comCompelling Clinic MetricsDavid Manning, CPA, CMPEManager in Health Care Consulting,Eide Bailly, LLPT. 701-476-8334dmanning@eidebailly.comThank you for your kind attention.
  • 66. www.eidebailly.comCompelling Clinic MetricsWho Has the FirstQuestion?

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